When A Child Is Born

I've written up all my own birth stories, but this is the story of the first birth I watched.

My little sister Sooz was 38 weeks pregnant with her third baby when Mum first got ill, and it became very quickly obvious that Mum was not going to be able to be her birth partner this time. So I volunteered, since I'm unphased by blood and gore and Have Had Babies Before.

Naturally, being a Sooz-baby, this one took her sweet time and things eventually got going eleven days after her due date. Sooz decided to go and be in labour round Mum's house, so Mum could be included, while I waited for news. After receiving some text messages that made me do this:

I got a message saying she was ready to go to hospital. So I loitered in the road, awaiting collection, and off we went to the maternity unit.

The maternity unit clearly don't believe women who ring in saying they're in labour, and so we spent some time sitting in the waiting room. Well, we sat: Sooz marched up and down, stopping every couple of minutes for a contraction, and then carried on marching. This is what is known as an active labour, and it is excellent for getting labour established. Sooz, like me, finds contractions much easier to deal with standing or leaning into something, so we had lots of stops for her to cuddle the reception desk or the bookcase.
After about half an hour, we were called to triage and Sooz continued to march until they put her on the monitor. It's hard to know quite what to do with someone in labour. When she was marching, I rubbed her back through contractions, but when she was lying down there wasn't a lot I could do, so I just pathetically stroked her hair until she told me to bloody stop it. She started to need to poo, but since she only felt this when she had a contraction, it was fairly obvious to me that what she really needed was to have a baby. She was not convinced. We sent her beloved partner out because he looked like he was going to faint, and then she suddenly went intro transition. Transition, if you're not aware, is the part of labour when the cervix stops opening and the uterus begins to push, and for some reason it makes women go a bit mental - pleading to go home or trying to leave is very common. Sooz just demanded to have the monitor off because she wanted to march!
So, the midwife had a feel and discovered that Sooz was indeed ready to push and her waters were on the cusp of breaking. She ran off to find a room while Sooz started shrieking about how elated and euphoric she felt because she was going to have a baby. She waddled across the hall to her delivery room, got on the bed, her front waters went splat and began to push before the midwife had even got the computers loaded up. She didn't make a sound aside from a tiny bit of groaning when the baby crowned, and then behold! A baby girl on a tide of water!

We arrived at hospital at around 8:45pm, went to triage at 9:15pm, went to the delivery room at 9:40pm and Evie Jo was born at 9:54pm.

I cut the cord (in one cut, which impressed the midwife) and helped Sooz get her on the boob and then came the difficult delivery of the placenta. She had ragged membranes around the placenta, which isn't unusual in deliveries where the waters break as the baby's born, but they didn't spot it until after she haemorrhaged. Sooz does not appreciate being stitched after delivery, and although she only needed one stitch for a first degree tear, FREAKED OUT at the very IDEA of it. After having the baby without so much as a murmur and no pain relief, she was huffing entonox like a teenager at their first rave. And, betwixt freaking out and crying with pain, she rode the wave of high and SQUEALED about being BOLD. It was fucking hilarious. I cannot tell you how much I regret not having entonox for any of my deliveries.

The doctor sat at the business end, fishing out all of the clots and membranes (squeamish to watch, unbearable to experience), while Sooz alternated shrieks and giggles. Her partner sat with the baby looking bemused and I looked on with interest. They started her on a syntocinon infusion and then finally left her alone to feed the hungry gurl!
I left around 11:30pm, having done my duty and aware that the parents needed to enjoy their new baby alone.

Not before snuggles though

So, how did it compare to my own labours? After all, you would think that being sisters, we would be similar in how labour and delivery worked, and we both have three babies.

Well, first as far as pain management goes, we are similar. Neither of us have had pain relief in labour, preferring to use movement and positioning (I dance and squat, she marches) to deal with the pain. I have been stitched without pain relief each time, although now I kinda regret that, whereas Sooz always has entonox because she hates it. 

Sooz tends to go into labour shortly after having a show, whereas I have never had a normal show, and what I have had has been anything up to ten days before the baby. My labours are much shorter and sharper. Sooz tends to have early labour in the morning, active labour by teatime, baby at bedtime. With each baby, her waters have only properly gone at the end. For me, labour has started with my waters breaking and once the contractions have started, progressed extremely quickly. Now, whether I would have laboured more like Sooz if my waters hadn't broken first each time, I don't know. I'm not going to do it again to find out!

She is much, MUCH quieter than me. It's characteristic for women to be vocal in the final stages of labour: it's one of the main signs midwives look for. Sooz is almost silent, aside from tiny murmurs. I tend to scream and swear and yodel my way through.
Transition is different too. Sooz had a very definite break between transition and beginning to push. I need to push before and then during transition, so I don't get any break. I do experience the feeling of calm once transition has passed, but not for any length of time and certainly no euphoria. Boo.
The biggest difference is probably in terms of the third stage. The WORST stage for me, because my uterus goes into atony and needs rubbing up (such a vile thing) to get the placenta out even with the active management, then I haemorrhage and it's just a bloody mess. Sooz has had two simple third stages, although this one was more complicated because of the retained membrane and untreated anaemia. She did extremely well.

Watching her go through the predictable stages of labour then birth really reminded me of my own experiences. I remembered more viscerally the pain and stinging and waves of contractions and the relief of getting the head out watching her, than I ever could just thinking about it at home. I felt it with her. It's a hell of a thing to watch someone push a baby out, but I really enjoyed it. When everything in our family is tinged with sadness, this was a moment of total joy.

Sooz was an absolute hero; brave and bold and noble Sooz, and Evie is a beautiful little piglet.

Infant Feeding

I've written about breastfeeding before, once or twice, but Jamie Oliver's gaping maw has popped into my newsfeed at least once an hour in the last few days and prompted me to write about it SOME MORE.

So, Jamie Oliver, King of Sugar Tax, is having yet another child, and has decided that his role of father to many and Britain's unofficial dietary watchdog means he is the perfect man to spearhead a pro-breastfeeding campaign. He wants British breastfeeding rates to rise because 

"It’s something that’s very natural to us - it’s easy, it’s more convenient, it’s more nutritious, it’s better, it’s free."

I'm sure Jamie has lovingly and easily breastfed every single one of his children, and will do again. I'm sure he thinks nothing of whopping a boob out in the middle of the night to feed the screaming baby, of sitting in Sainsbury's café feeding his child with vigour. I'm sure he has suffered the perils of mastitis, and engorgement, and sat weeping because of cluster feeding on many occasions. After all, Jamie knows, man, he just KNOWS how easy breastfeeding is because he's done it four times now.

Oh wait, hang on, no that's Jools who's done all that. Likely while Jamie makes yet another stupid torn up salad out of ham and figs and pomegranate and shouts pukka, after which Jools, weeping, scrapes it into the bin and silently makes beans on toast for the children who won't touch those funny bits of seed, while Jamie leaps around his garden, ejaculating over his broad beans.

I have breastfed for five years and seven months out of the last seven years, 71% of my parenting life has been spent with a baby or toddler attached. One of them had a formula bottle once, but otherwise, it's all been me. Sometimes it has been like the antenatal literature tells you, all magic and beauty and skin to skin and love. Sometimes it has been so shit, I have cried, I have ranted, I have considered jumping out the window, I have BLED, I have been infected, I have been sore, I have dripped milk all over my clothes, I have had to feed a screaming baby on a toilet. Breastfeeding is in no way, shape or form easy. It is rewarding. It is even lovely. But easy? Fuck off, Jamie. Have someone hanging off your chest all day and tell me it's fucking easy.

Now I grant you, it CAN be very convenient. My youngest has been ill for the last few days and all he has wanted is milk, often at 3am while running a very high fever, and I have been able to just flop out my boob in bed, and go back to sleep. I am lucky, I have gigantic boobs that allow me to do this. But can I go out with my husband for a meal, or the cinema, or the pub? NOPE. Is it convenient to START breastfeeding when you've just pushed a whole fucking person out of you, or had major surgery? Is it convenient to be awake for thirty six hours straight after doing that because you don't know what the hell you're doing? Nope. Breastfeeding needs to be established before it can be realistically regarded as convenient, and establishing breastfeeding is where the nation's breastfeeding statistics fall down. It is hard. You get shit, contradictory support when you get it at all. The support, emotional and physical, is often not forthcoming. 

Nutrition is a thorny issue as well. The problem with infant feeding studies is that they are frequently biased in favour by whoever commissioned them. There is ample evidence to suggest both formula AND breastfeeding are better than the other. Plenty of breastfed babies are plagued by illness and allergies, and vice versa. I would like to think breastfeeding is healthier, and the WHO supports this, but the easily available information (i.e. non-academic reports of studies) is on the fence.

Is it better? Well, that's also a thorny issue. Oft have I mentioned that I was formula fed because my mum had supply failure and NOBODY SPOTTED THIS. For ten weeks, I got a tiny bit of foremilk with every feed, lost over a pound in weight and nearly bloody DIED before I finally went to see a paediatrician who recognised I was starving and switched me to formula. This is very rare, very very rare, but it happens. 

And is it natural? Well yes, but regardless of how natural it is, a lot of women find breastfeeding physically very demanding, if not impossible. Theoretically, every woman can breastfeed, with some very rare exceptions, but we do not live in theoretical land. Women on certain mental health medications cannot breastfeed, and have to choose to either run the gauntlet of perinatal mental health without medication or while trialling something else. That's a difficult and potentially dangerous decision to make. Most women find breastfeeding intensely painful at least once during the early days, and if they can't cope because they're in pain everywhere, who can blame them for stopping? If your nipples are flat or inverted, you have to be told a thousand conflicting opinions on whether or not to use nipple shields, all the time feeling shittier about the whole thing. And then there are tongue ties, which sound like a made-up-thing, but is a condition where babies can't latch because their tongue is stuck to the mouth, and is either inflexible or too short. This should be dealt with at birth, but often isn't. There are myriad other physical problems, from persistent mastitis, to undersupply, to oversupply, to milk allergies, to other food allergies. 

There are literally thousands of things all women's bodies are supposed to be able to naturally do, like menstruate and conceive, and walk, and talk, and see, and hear, and give birth, but we accept without question that some women cannot. Why not breastfeeding? When was the last time you heard someone tell a blind woman that she SHOULD be able to see because seeing is NATURAL? Precisely. 

It's free. Well, yes, emotional, social and psychological costs aside, it is free. Does that make it better because it doesn't put money in anyone's pocket? What if Jamie released his very own Jamie Oliver's Well Pukka Innit Formula? Would that be better?

You see, Jamie seems to have an issue with formula advertising. I won't lie to you, dear reader, I also have a massive problem with formula advertising, but mainly because it's so fucking TWEE, and full of LIES, as well as suggesting that IF ONLY YOU WOULD STOP THIS LUDICROUS EXTENDED BREASTFEEDING OF YOUR BABY, you could have the LIFE YOU HAVE DREAMT OF! 

I don't know if Jamie is aware that it's illegal to advertise formula for babies under six months old, but even if it wasn't illegal, every single mother gets to choose (at least to begin with) how to feed their baby. Women are not stupid. Women know if they don't want to try breastfeeding (and lawd knows you're given enough bollocks if you formula feed from birth), they are not swung by shiny adverts. Literally the only attention most women I know give to brands of formula is whether or not their baby will actually drink it. 

Jamie thinks formula makes you fat. There IS a study that links birthweight and placental size ratio to later obesity and hypertension (Southampton Group Longitudinal Study), but the main things that make you fat are your lifestyle, your social status, your wealth, your health, your access to a variety of affordable food, and your access to exercise. We don't magically make thin adults through breastfeeding. 

But this is how Jamie works. Sugary drinks makes us fat: let us tax sugary drinks and thus people will magically become thin. Breastfeeding makes us thin: let us encourage breastfeeding, and lo, people will become thin. If it was as simple as "breastfeeding is easy, let us breastfeed", the rates would be far higher.

But the biggest thing that has struck me about Jamie Oliver and his Thoughts On Breastfeeding is how often infant feeding is seen as a moral judgement. 

You are not a bad mother if you choose to formula feed from birth.

You are not a bad mother if you choose to breastfeed from birth.

You are not a bad mother if you end up formula feeding anyway.

You might be a bad mother if you feed your baby nothing but ground glass and methadone, but otherwise 

INFANT FEEDING HAS NO MORAL VALUE. 

Every newborn baby has to be fed. They have to be. You don't have a choice. You have to get something in to them eventually, even if you struggle for the first few days. Babies can survive a surprisingly long time without food, but eventually, food must be given. Regardless of what some blogs may make you think, you don't win any prizes for breastfeeding. And if you feel the need to publicly criticise women for formula feeding, then you are proof that breastfeeding does not necessarily make you a good person. 

So think on, Jamie Oliver.

Breastfeeding Tips

So, since my Alex was born last month, I've restarted breastfeeding. It's only been a year gap since I weaned my middle boy (aged 3, where's my fucking medal?) so I wasn't expecting it to be too big a deal. Indeed, the hospital were so taken aback by my willingness to feed and reluctance to be 'shown how' that they wrote "declined support" in the breastfeeding part of my notes.
But it's actually been harder than I expected. Not because of Alex: he's a good feeder and ACTUALLY SLEEPS PRAISE GOD. But because I forgot about feeding newborns and how exhaustingly full on it can feel. So, here's some top tips on establishing breastfeeding that you didn't ask for.

1: Get comfy
It is a lot easier to relax and feed your kid if you're comfortable. First, grab a drink, and your phone. Go to the toilet if you need to: baby won't actually scream himself to death in 60 seconds. If you're not comfortable feeding in front of people, go find a more private space. If you're leaning up in bed, support yourself with pillows. If you're in a chair, sit back and put the telly on. Bring the baby to your boob, rather than your boob to the baby because that way lies stiffness and aching which might just be too much in the postnatal awful. Some babies take 20 minutes to feed, some take 5, some take bloody hours. You don't know how long you're going to be in that position, so start right.

2: Lanolin cream is your new God
Your nipples are not used to being sucked in the vice like grip of a baby's maw, and can get quite sore even from one bad latch. Lanolin cream is safe for the baby to suck, so you don't have to worry about it poisoning him, and it turns nipples bulletproof in days.

3: You don't have to put up with a bad latch
Babies, in their desperate haste to eat yet more milk, will occasionally snap onto your boob wrong. You know it's wrong because you shriek, and then sometimes, you bleed. If you do bleed, by the way, it won't hurt the baby but if the blood is coming from inside your nipple, tell your midwife or HV.
Should the baby latch go awry, pop a finger between baby's mouth and your nipple, and try again. Do not leave the baby latched wrong, however much he squeals in indignation that you've stolen his food. Aim your nipple at the back of his throat, wait for him to tip his head back with his mouth like a baby bird, and shove it in. You won't hurt him. Even at a month old, Alex still needs a bit of a prod to stop him sucking his fist or arm instead of the perfectly good boob millimetres from him.
A good latch might feel a bit uncomfortable and strong, but it shouldn't make you scream. Ask for help if you cant seem to get the hang of it.

4: Engorgement feels like hell, but it is normal.
When your milk comes in, fuck a duck it hurts. It is often accompanied by the three day blues, which make you hate the world and weep over nothing. Giant, rock solid boobs, with fluey symptoms and uselessly unsupportive nursing bras make everything worse. But guess what? It lasts about 24 hours and then it's done. Cold cabbage leaves really do work and so does a warm shower.
You GAVE BIRTH: you can do this.

5: Cluster feeding is also normal
Cluster feeding is how babies tell boobs to make more milk, usually in response to growth spurts. But I have never seen it mentioned in breastfeeding help from official sources, and it nearly drove me to despair with my eldest. Basically, your baby will feed pretty much non-stop for four to six hours, commonly in the evening when you are tired and wanting the baby to get off and let you sleep. It can, however, prompt relatives to ask if you're SURE the baby's getting enough, and suggest that maybe you should stop feeding (see 9 for more on this). It is a recipe for crisis if you're not sure of yourself. But know this my friend, it is normal. Your boobs are amazing at responding to the baby's needs and it only lasts a day or so at a time.

6: Breastfed babies get wind
Some people think they don't. Trust me, they do. You can feel it in their solid little bellies after a feed (normally, there is squidge). Sit them up, let them sick it up a bit and then offer some more if they're still rooting.

7: Don't be afraid to ask for help
Birth can make women feel incredibly insecure and stupid. Midwives can (if you're unlucky) exacerbate this by making it look SOO EASY to feed babies. They come along and force the baby's head on your boob as if by bloody magic, leaving you none the wiser as to how to do it. Then they want to observe you feeding, which is hardly confidence inspiring. Then they give you conflicting advice. So, assert yourself a little. Ask them to slow down and show you properly. Personally, I found the pictorial guide in the NCT booklets better than anything anyone could tell me. If you're worried about anything - bleeding nipples, sicky baby, baby who won't stop crying, baby isn't interested in feeding, baby who never stops feeding, the way you feel - talk to your midwife or health visitor. Remember,  they want you to breastfeed too. You're not on your own in this.

8: Eat. Bloody eat! And drink!
You are a milk factory. You cannot make it out of thin air. Eat! Drink!

9: You are allowed to tell people to piss off if they're being shit
If your baby latches, wees and poos and seems happy, then you're doing great. Family, particularly when they haven't breastfed themselves or if it's been ages, can be surprisingly pissy about the choice to breastfeed. THEY WANT TO FEED THE BABY DAMMIT. Well, they can't, and if they could it's not like they're going to come round and do bottles at 2am for you, is it?
If they're really getting you down, suggest they:
- Sit under the baby for two hours while you have a nap/a bath/a leap around the garden because your arms are finally free
- Bath the baby
- Cook you some food and stop being so fucking negative
This also applies any time people decide you are Doing Parenting Wrong because you're doing something they didn't.

10: It's OK not to breastfeed

Fuck knows it doesn't feel like it, but sometimes it just doesn't work, or isn't compatible with the way your life is. And that's OK. The baby needs feeding, you need your sanity, and these are both more important than the method. I was formula fed myself, so I can vouch for its life giving properties, and nearly starved to death first*, so I can also vouch for breastfeeding going wrong having severe consequences. Do what is right for your family.

Here, have some handy links:

NCT Breastfeeding Help

La Leche League

Kellymom US Breastfeeding Advice

NHS Breastfeeding Site: includes helplines

* This was due to supply failure. This is a very unusual breastfeeding problem, that your HVs or midwives will pick up on through failure to thrive rather than just thinking the baby's not feeding enough. Don't mistake cluster feeding for not producing enough milk, but do get your baby weighed if you're concerned they're losing weight.

Birth Story - Alex, 2015

IN BRIEF:
Gestation:39w 5d
Site: Hospital
First Stage: 1hr 35min active labour
Transition: One contraction's worth
Second Stage: 10 minutes
Third Stage: 20 minutes
Tearing: Mainly external second degree tear
Weight: 8lb 10oz

Details:
As some of you know, I had been quite terrified of going into labour with this baby. My history of short labours and PPH (post-partum haemorrhage) plus generalised anxiety genuinely made me fear we would both die if I went into labour with nobody around to help. I think my body knew that, because despite two weeks of prelabour, nothing kicked off properly until the older boys had gone to their dad's and Tom was home from work.
Early on Friday evening, I started to get a burning cervical pain. I'd been getting a lot of pressure for a few days, but this was really uncomfortable and specific, so I could barely sit. I rang the hospital and they said it was more likely to be thrush or a UTI than imminent or silent labour, but considering my history, to come in to be checked. I didn't really think it could be labour because he wasn't due til the 6th, and other people have their babies early, not me!
Off we went, and had to wait for HOURS to be seen because they had several emergencies - Friday night is party night in delivery. I had a normal CTG. The obstetrician thought it was probably a UTI as I had a lot of leuks and protein in my wee, but my cervix was still thick, and 2-3cm dilated, as it had been for the previous two weeks. I got some antibiotics and left, starving and tired at 11pm. When we left, I didn't want to get out of the car. I had a strong urge to be safe at home, so Tom took me back and went into town to try and find some food. When he rang to tell me he couldn't get anything, I started to cry, which is rather unlike me. He went to McDs and then came home, knocked on the door for me to let him in and as I stood, my waters went CATASTROPHICALLY. It was a veritable DELUGE. I must have lost two pints in the first gush. I managed to get the door open, and then started giggling for joy. I rang the hospital who were sceptical about my need to be admitted immediately until I told them that my consultant had told me to insist on it. I couldn't eat because I knew I was likely to be sick in labour, and leaked about the house while Tom ate his burger.
My waters broke (the first time) at 12:10am.We got to hospital around 1, were seen around 1:30am in triage. I had some fierce backache, but no real contractions. I'd wodged a huge towel between my legs to try and catch the river, and the midwife asked if I hadn't got any pads. My waters had already soaked through two pairs of trousers and pads, I thought a towel might be more dignified...
I went on the monitor, and had a couple of painful contractions. On VE, I was 2cm stretching to 5, and admitted on the basis of previous precipitate labours. I wasn't in much pain, and was still quite joyful at the prospect of incoming child.
I was moved into a delivery suite around 2am, and nothing much was happening aside from the BIBLICAL STORM outside. If you missed it, shame on you - chain lightning, forked lightning, drunks outside A+E stumbling around in the rain. Gorgeous. Ahem. I was cannulated in case of PPH, and had some bloods done. I was then monitored for bloody ages. Alex's heart rate was ALL OVER the place. He was decelerating and accelerating and generally being very worrying, but because I wasn't technically in established labour, they were happy to wait and see if he settled down when labour settled in. I spent most of the next three hours alternating between being monitored and jigging about the room in soggy trousers, trying to get labour going. My waters didn't stop breaking until around 6am, and there were pints and pints of it. I can't believe how much there was. Me and Tom both kept nodding off, although I was getting one contraction every 15 minutes. They prepped my syntocin drip ready for afterwards. I explained that my cervix did not dilate as they're supposed to, but I only actually had two VEs from when my waters broke, which was great.
At 5:15am, I had another VE which was 4cm, stretching to 7 or 8cm, but this still didn't put me in officially established territory.  Nonetheless, the VE got me going, to about one every four minutes. Annoyingly, I had to stay on the CTG throughout because he was still decelerating. I had the same midwife with me (Nina) throughout, and she only left for breaks (in which case someone else came in) or to get someone else to check his trace. This surprised me - I thought I'd be left to get on with it, and I did find it a bit inhibiting to begin with. Once I got going, there could have been a circus in there and I wouldn't have noticed.
The contractions lengthened and got a lot more painful. I was starting to get quite vocal during them, and hallucinating between them as I did in strong labour before, and my official labour start time was 5:55am. However, Nina kept telling other midwives I wasn't established, presumably so they didn't panic about the CTG. It didn't feel like my other labours because I had to be lying down - it made me feel rather detached, and although they were more widely spaced than if I'd been mobile, they were also more difficult to cope with because I couldn't use my body position to cope. Also, the CTG was registering my thunderously vicious contractions as 30-40, instead of 100, which made me wonder if I was actually progressing at all.

The next hour or so is a total blur. I had to stay on the bed. Tom was there the whole time, but I had my eyes shut through most of it. I got onto all fours, so I could let gravity do its thing, while staying on the CTG. Then I asked to go to the toilet, for a wee, because I was feeling pushy and I badly wanted to stand up for a minute. Going for a wee was an agony of blood and pain. Nina gave me some dextrose tablets (I hadn't eaten since Friday lunch) and I got back onto all fours, leaning into the back of the bed. She rubbed my back, while Tom held my hands. I remember telling Tom it was nearly time. A midwife came in to review the trace and organise shift handover, and said I was going to be referred to the coordinator for a caesarean, because of his heartrate (this wasn't actually discussed with me or stated explicitly, but I know the drill). I hit transition around then, and my legs started shaking uncontrollably, I felt sick and I told Tom he wasn't allowed to go and I wanted to go home and I couldn't do it anymore.
Then I began to push, so Nina got between my legs to monitor him, and just let me get on with it. I tell you now, giving birth without people telling you if you're allowed, or what to do is the best bloody way! Two other midwives  came in then to take over the shift from Nina (who had already told me she wanted to stay until he was born) and were quite surprised to find me pushing since they'd been told I was 4cm and not established. I felt like it was very much my party - nobody told me what to do.  It didn't take long at all, only ten minutes. I started screaming that it burned when he crowned, but otherwise I tried to be quiet and just pushed. I managed to mostly pant his head out and his shoulders took a bit longer to be born than I was expecting, but then out he came! He was a bit wrapped in cord, but I had my back to them so I'm not sure how bad it was.
I had him at 7:41am, four minutes before Nina's shift finished! I went a bit "Oooh, I had a baby", because it didn't really feel real. They helped me get onto my back and I started to haemorrhage immediately. They gave him to me and I haemorrhaged some more, so they plugged my syntocin in quickly. I lost about 500ml, so not as bad as last time. Alex was quite bluey purple and still properly covered in vernix. He took a while to go pink, but his Apgars were fine.
Then came the placenta. Even with the syntocin and syntometrine injection, it took a while. It was a bit tangled up in membranes and my body did not want to push it out. They got it out in one piece after about twenty minutes, while I was feeding the baby.
Then, bloody horrible stitching. I didn't tear too badly this time (2nd degree, mostly exterior) but being examined by a student with shaky hands was deeply unpleasant. However, when they'd finished and gave me the best tea and toast in the world, I was much improved.
They weighed and checked Alex. He is 8lb 10oz, so a little smaller than we expected but not much. His head circ is only 36cm, which is MUCH smaller than I expected, and quite a relief.
We sat around waiting to go. My drip took 3.5 hours to get through and they wouldn't uncannulate me until it was time to go in case I suddenly had a haemorrhage again. He passed his hearing test first time, which surprised me because he had such a soggy labour. The paediatrician (who I'm sure I went to school with) didn't come round til gone 2pm. Alex is all normal. Then my midwives started to discharge me, got halfway through and called to an emergency, and then we sat for an hour waiting for someone to finish it off. He pooed all over the discharging midwife. We finally left around 5pm, by which time I was heartily sick of hospital having been there (with a break) for almost 24hrs.

I think this was probably my easiest birth. It was frustrating being hooked up and immobile for hours, particularly as I'm sure he would have been born sooner if I'd been allowed up and I couldn't really tell how I was progressing because it feels so different from being active in labour. BUT his actual delivery was really good and felt much more natural and easy than the other two and I didn't have quite as bad atony in the third stage as before. I didn't want or need any painkillers, which totally shocked all the midwives, but what's the point for two unbearably hard contractions? That's all it was as well - and they didn't seem to get to the point where they rolled into each other, so I was still getting breaks right up to transition. I was worried before that having him on the consultant led unit would mean a lot of intervention and trying to make my body go by the book, but despite being monitored, the midwife was quite happy for me to get on with it on my own terms.
Alex is beautiful and looks just like his brothers.
I never want to do it again, but I'm so glad it went well.

The Postnatal Survival Kit

I'm now 37 weeks pregnant, and at that point in pregnancy when people start asking if I've packed my hospital bag yet. Yes, yes I have. After seven months of refusing to buy anything for the baby (mainly out of terror), I've bought practically everything in the last 4 weeks, and shoved it in a rucksack.

But nobody ever asks if you've got everything ready for afterwards - nobody wants to remind you of the traumatic week after having a baby when everything seems to be falling out of you. Or they assume you're ready, one or the other.

Anyway, as this is my third baby, I'm READY! SO READY! And here are my postnatal essentials...

1. Painkillers.
It doesn't matter if you have a fast labour, a caesarean, or an instrumental delivery. It doesn't matter if you tear or not. Having a baby hurts like a fucker, particularly afterwards. "But oh", they tell you, "as soon as the baby's out you forget the pain!" Not if you get afterpains you don't. Birth carries a payload of hormones to carry you through the delivery and into the euphoria of YAY! BABY! Then the hormones settle down, and it's bloody sore and crampy and weep-inducing. In addition to this, it's ingrained into you from CONCEPTION that only the weakest paracetamol is safe to take, and even that's a desperate measure. Once that baby is out, embrace the painkillers. I have got DELICIOUS, FORBIDDEN ibuprofen and some co-codamol in.

2. Maternity pads. Lots of maternity pads.
Another thing often neglected to be mentioned in The Joy Of Birth is that you bleed like a stuck pig for some days afterwards. Maternity pads are advised over regular pads partly because of the chemical crap they put in normal pads (floral menses, yum!), partly because no regular pad will stem the postnatal flow. And no, you really can't use tampons. With my last baby, I used 12 pads a day to begin with, despite having had a postnatal haemorrhage. Mothercare, wondrous place, do maternity pads with wings. I cannot praise them enough.

3. Breast pads. Lots of breast pads.
It doesn't matter if you're planning to breastfeed or not, most women will still pour forth milk for some days after the birth (weeks, if you do breastfeed). And it happens at the most irritating and unexpected times, like you smell the baby and you boobs go, or you think about how small the baby's toes are and your boobs go, or you're in Tesco and you see a pregnant woman, and your boobs go. It is annoying. I'm a lucky beast who doesn't tend to pour forth milk after the first four weeks, because my letdown only works during feeding, but I still get through boxes of the things to start with.

4. Lanolin Cream
If you do breastfeed, this cream is a marvel. What nobody tells you before you have a baby, probably to try not to terrify you out of it, is that breastfeeding can give you sore, cracked nipples. It's really quite an obvious thing when you think about it. My first baby had me bleeding all over the shot to begin with, until I got some magic Lansinoh, and within days my nipples were bulletproof. I used it again with baby 2, and will use it again with this one, although I've got Medela Purelan this time because it was much cheaper. Stick it on after every feed, and you should be fine.

5. Anusol and Lactulose or Fybogel
When you push a baby out, you can end up with piles. Piles are enough of a problem when you're pregnant, but after birth they can get really quite annoying. Anusol is your friend. Then there's constipation. I've torn badly with both previous babies and become so terrified of crapping that I've made myself ill. Even with the time honoured advice to hold yourself with a damp flannel while you go has been insufficient to get me through. So this time, I'm not risking getting ill - Lactulose from day 1, thank you.

6. Iron
If you're on prescribed iron when you get close to birth, make sure you've got enough to last a couple of weeks postnatal (yes, you do have to assume you'll go overdue). If you think you'll run out, get an extra prescription. If you're not already on iron, get either supplement tablets or Spatone/Floradix\Feroglobin liquid iron. You lose a lot of blood when you have a baby. It's blood you can afford to lose, because of the extra that's been sustaining your little one for months, but it is a sudden drop and can make you feel much more tired and crap than you necessarily need to.

7. Pajamas and Slippers
This may seem a bit of an anomaly in this litany of postnatal woe, but I always treat myself to nice, new pajamas for after I've given birth. I don't believe in getting dressed for the first week postnatal - anyone coming round is going to find me boobs akimbo, hair everywhere, stinking of lochia, covered in children and possibly weeping, so whether I'm fully dressed or not makes little difference to their perception of me. Mothercare do really lovely nursing pajamas (with button down fronts). I'm still wearing the pajamas I got from them in 2011, so well worth the investment.

8. A Nursing Pillow or Extra Pillows/Cushions
A boomerang shaped pillow is amazing when you've just had a baby, regardless of how you feed them. It gives you a way to support their useless neck without actually having to hold them up too much. Extra pillows will also do the job, but I find a boomerang useful for all sorts of things, not least propping me up to eat in bed.

9. Canned Drinks
I get bloody thirsty feeding a baby. This time, I have a husband to make me endless tea and drinks, but I assume he will also want to sleep occasionally, so canned drinks are the way forward. Unhealthy, yes, but this is about survival.

10. FOOD
You have to eat when you've had a baby, and yet it seems to be something easily forgotten among the chaos of screaming, poo and a baby who has no idea how to tell the time. Nothing will help your recovery quite like loving support, sleep and food, and if you can't get enough sleep, food will do. Fuck your postnatal diet. Fuck any pressure to fit back into pre-preg clothes. That can wait at least a month (or forever, if you're me). Eat what you fancy, when you fancy it, moreso if you're breastfeeding - you really do need a LOT of calories to get the milk factory going. If you've got other people in the house to feed, make some meals in bulk for the freezer before your due date. You can find recipes on the BBC Good Food website, including cook-from-frozen instructions. Write these instructions down on the frozen food container, so anyone can reheat them. If people are coming to see the baby and have the courtesy to ask if there's anything you need - food. I think baby cuddles for cake are a fair exchange ;-) If family offer to bring you round meals, accept gratefully. It's been months since you could eat normally, so take advantage.

For a less miserable postnatal view, you may also like my post on things to look forward to.

University Year 4: Complete

Another year of uni is over. I have time, at last, to focus on my special summer project. It's a little more intensive than the usual voluntary census transcription...

How did it go? Well...I WANTED to be pregnant this academic year, so I only have myself to blame for the difficulty of it all. I thought I knew how difficult it would be, reasoning that doing the previous three years with an autistic preschooler/child and a baby/toddler/preschooler was quite hard as well. I did not know how hard it would be. It was...fucking hard. I got pregnant pretty much the week the course started, and was plagued by anxiety, exhaustion, nausea, sciatica, pelvic pain, anaemia, ligament pains, oedema (thank you, summer) and the mental treacle of baby brain. I am never doing it again.
These are my OCAS marks. Not bad for such a crap eight months:

The EMA for K311 was a huge challenge, which I perversely rather enjoyed, but it's not exaggerating to say that module was one of the hardest things I've ever done.
I did the exam for SDK125 this morning. I couldn't start revising (well, in any meaningful way) until I'd got the EMA submitted, which gave me a little over a week. I revised like someone of brittle sanity until about 10:30 last night, when I figured if I don't know it now, I'm not gonna know it. I think I probably passed, although I probably should have checked I had a calculator that could cope with numbers like 0.4x10¹⁴. I got the exam done in 70 minutes (the hit and run method, my favourite) and escaped in a rush of joy...without my cardigan. I have to say, the OU are brilliant if you're very pregnant and doing an exam. I could have done it at home (being 36 weeks today), but instead was permitted to take a cushion in to sit on and have half an hour rest if I needed it.

I find out if I pass about a week after the baby's due. I cannot imagine I will care ALL that much by that point, but I would prefer NOT to resit anything.
I am a glutton for punishment, however, and start again in October doing my FINAL MODULE. The end is in sight. I've signed up for K319: Adulthood, Ageing and the Lifecourse, a 60 credit level 3 course. We just have to hope the baby likes sleep, and doesn't object to mummy being on the laptop for the duration of the school day.  I'm quite prepared to defer if I have to, but I do like a challenge. Masochism runs strong in my blood.

And after that? A masters, perhaps, but more on that if I ever finish this bloody BSc.

Things To Look Forward To

I've reached the "fucking fed up" stage of pregnancy now. Not QUITE at the "so fucking fed up I just want him out" stage (let's not get ahead of ourselves), but almost. I have begun to dwell on all the things I will be able to do in a few weeks...

Like... SLEEP ON MY FRONT. In fact, sleeping in any position that doesn't cause pain will be a novelty. Such is the state of my pelvis that I cannot sleep on either side, or my back, without waking up in pain and walking like a newborn fawn. A really bloody fat newborn fawn. Oh to wake up without backache, without feeling like someone's crowbarred my pelvis open at the sides, without my thighs hurting for NO GOOD REASON. It will be beautiful.
And DRINK WITHOUT IMMEDIATELY PEEING. Oh the joy of an unburdened bladder. You know not your fortune in being able to sleep all night without waking up from your unborn gently headbutting you in the bladder.
No more MORNING SICKNESS. It is a universally accepted myth that morning sickness only lasts for the first trimester. It does not. Well, I suppose for some lucky beasts it does, but I'm not among them. No more will I vomit into the kitchen sink while my other children shriek "MUMMY! DON'T BE SICK IN MY BREAKFAST".

While we're on the subject of food, EATING PROPERLY will be amazing (and relatively guiltless on the breastfeeding diet). I can't eat a full meal. I'm too full of child. He's quite a big baby (on course to be at least 9lb at birth) and I have his head in my bladder, and his arse in my stomach. I throw up if I eat too late, or too early. I miss food. I'm almost never hungry, because of the pressure, but sometimes I will get very hungry for very specific things I cannot have, like...Mr Kipling apple pies at 11pm. Or mustard. Or I'll really fancy something at 4pm, but by the time my husband brings it proudly home from work, won't be able to abide the sight of it.
And eating ALL THE FORBIDDEN THINGS will be amazing as well. It wasn't too bad when it was colder (except Christmas) but this time of year, all I really want is stinky cheese, wine and paté. I know, I should have been French.
AND not getting INDIGESTION. Of all the hateful pregnancy afflictions, not being able to drink my permitted cups of builder's tea without getting fearful indigestion is probably the cruellest.

Then there's the physical bonuses of not lugging a huge bump around 24/7, like BEING ABLE TO BEND. Currently, I have to get on my knees to pick up the countless toys and clothes scattered about the house, and to load and unload the washing machine.
Not to mention BEING ABLE TO WALK UP THE STAIRS WITHOUT DYING. This is not wholly the child's fault; I'm quite anaemic and breathless fatigue is an annoying side effect.
And I'll be able to SEE WHERE I'M GOING. I can't see my feet. I can't see anything below my midline, including my younger son who is short. I am forever stepping on lego and have to scan the kitchen floor for slugs if I go in there at night, lest I have a terrible,  labour-inducing horror shock. 
And I won't be BEATEN FROM WITHIN anymore. This baby is lying on his side. His brothers preferred to lie on their front and beat the shit out of my placenta, which I couldn't feel. This baby is all limbs (hence his nickname: Squid), and gets his feet under my ribs while he puts his hands under my pelvis and then PUSHES AS HARD AS HE CAN, which is pretty fucking hard considering how tiny he is. 

I'm well enough versed in motherhood to know this exhaustion isn't going anywhere when the baby's born. BUT I will at least be ABLE TO SLEEP. Currently, my body gets really tired around 2-4pm, and then again around 8:30pm and if I don't go to bed, it wakes up and goes on the alert until around midnight. This appears to roughly coincide with the baby's sleep pattern. In my experience, I will be able to fall asleep standing up once the kid is out. Hurrah! I may even be able to CONCENTRATE. You try revising for an exam at this stage of pregnancy. Tisn't easy. I can't even read a magazine without getting distracted and staring into space for five minutes.

Oh, there will be all the negatives of birth as well. Stitches, arse pain, constipation, aching, bleeding half to death, Lola Ferrari boobs, milk spurting everywhere, HATING THE WORLD, being so tired I might die, getting peed on, shit on, sicked on (and that's just my husband...lolz), getting cried at every 20 minutes for five hours. But ... FOOD. AND BENDING!
Five more weeks til I'm due. Nearly there.

Planning A Birth

When you are pregnant the first time, all the baby magazines, books and websites talk about your Birth Plan, as though it is something enshrined in law. While your midwife concentrates on various medical choices, which either horrify you or go straight over your head, the baby media remind you that you should pack incense and candles and soothing music. The reality of a first birth is usually some miles away from the happy ideal of the joyous birth plan. In fact, the birth plan is usually ignored. No pain relief sounds a noble thing indeed until the 36th hour of labour. No amount of Enya is going to stop you screaming like a banshee at some point. And that's fine.
I would argue that giving birth for the first time is inherently traumatic, regardless of how natural and beautiful it's supposed to be. It would certainly explain the vast numbers of women who speak of their first delivery in terms of awestruck horror. I certainly found my first birth traumatic, although most other women regard it with a mix of disdain and envy. Only four hours of labour? Lucky bitch. Yeah, four hours of labour is fine until you're going down the A47 at 80mph in the middle of the night, trying not to give birth in the front seat. That is less relaxing.
I was strongly advised to have a homebirth with my second baby. This was no problem for me: not only was my first birth traumatically fast, I also had an absolute shit time on the postnatal ward and was left in a very fragile mental state for six months. I blamed my postnatal depression mainly on my poor postnatal experience, and was scared it would happen again.
So, when the time came, I popped my middle boy out at home. I was considered low risk in comparison to the high risk of precipitate labour. As far as the labour and delivery went, it was beautiful and just like birth is SUPPOSED to be. Then it all went to shit.

I thought I was OK with my second birth. My baby was alive, somehow. I was alive and safe if a bit fucked up for a week, and I'd done it at home all by myself. It was a lot more controlled and easier to cope with than the first. I drew a line under it.

Or I thought I did, until I got pregnant again.
Initially, I thought I would have a homebirth. As pregnancy progressed, I realised that I was actually quite terrified of having another homebirth. They're great. They're lovely. They're amazing. Until they go wrong, and then they are SHIT. You have to hang around waiting for an ambulance, get dislodged from your comfy house to go and lie on a horrible hospital bed. And that's if you manage to get your baby out first - the idea of doing the same IN LABOUR fills me with horror.
My consultant got my notes from my old hospital, and said it would be a lot better if I had the baby on the consultant led unit so they can treat me immediately if I haemorrhage again.
And what upset me was not that the decision to have a homebirth was taken away, but that I no longer felt able to trust my body how to have a baby. I no longer WANTED to have a homebirth, and that felt very strange to me.

I've got 46 days to brew, give or take a fortnight. And I am dreading birth. I don't want to go into labour - not enough to be induced, which has been offered, but enough to already be second guessing my body's various twinges. I am scared of haemorrhaging again, scared of tearing, scared of everything. It sucks. I have never feared birth before, trusting wholly in my uterus to do what is expected of it, but now I am full of doubt. I sincerely hope that I am so sick of pregnancy that I welcome it by the end, because this anxiety is all new. It may be because I *know* this baby is my last, and I feel pressure to get it right, to minimise the curious feeling afterwards that I need to do it again to make it right.

There is no such thing as a perfect birth. There are only births that are good for the individual, and being realistic in your aims and expectations is the first step. I expect to give birth without pain relief - I have twice before. I expect to refuse induction unless the baby's distressed - I'm like that. I expect to be allowed to labour without monitoring or VEs - I've always laboured at home, so this might be a bit more of a stretch. I expect labour to be fast - if it's not, I shall be surprised! I am prepared to labour too fast to get assistance, which is part of the fear. I expect to haemorrhage, but I hope I won't. I expect to need surgical repair, but really hope I won't. I expect a big baby.
But that's all I expect. Everything else is too unpredictable to even think about trying to plan for.

Birth Story - Jack, 2011

I'm putting these up here for posterity's sake, rather than to horrify you all while you're eating your lunch, so please skip unless you love gory, onomatopoeic descriptions of birth. 

IN BRIEF:
Gestation: 42w
Site: Home
First Stage: 90 minutes active labour
Transition: About two minutes
Second Stage: 20 minutes
Third Stage: Ages and horrific
Tearing: Deep, extensive, borderline 3rd degree
Weight: 7lb 12oz

Details:
The day before he was born was Easter Sunday. I felt odd all day. I had a few really vicious cervical pains, but nothing major or long. My sisters all came round so we danced. Really danced. I was buggered up afterwards, but evidently it worked. I kept feeling like my waters were going to break, but kept telling myself it was wishful thinking because I was getting closer to bedtime and my admission was looming. Everyone went home after dinner and I got Jimmy to bed, then went down to watch TV with Mum. This was around 9pm. I didn't feel right. I wasn't in pain, just felt restless and inverted. I had some ice cream and then felt like I was weeing. I said to Mum "Either my water just broke or I'm incontinent". I asked her to come to the loo with me to check and when I got to the bottom of the stairs, it just POURED out. I went to the loo and it was clear with some blood in, but definitely water rather than wee. A load more came out on the loo. Mum went a bit hysterical - I think coz she was pleased it was finally happening rather than panicked - and got a shower curtain on the sofa in case I kept leaking. I called the midwife and she phoned back a few minutes later, saying she'd pop out around half 11 (my waters broke approx 9:30) and I phoned the ILs to come and get Jimmy. The midwife phoned again while the in laws were round to say she was gonna come over sooner rather than later. Then I kissed my Jim goodbye and sat in curious limbo waiting for the midwife. I text his dad and told him my waters had gone and got back "OK. Good luck". lol.

The midwife (Suzy) turned up at half 10 and checked me over. My fundal height was 33cm by then - 9 weeks behind! She didn't want to do a VE until I was in labour coz of infection risk, so I took a low vag swab and she checked my wee and obs. Then we sort of sat around chatting. I'd had one, painless contraction before she arrived so she waited for me to have another. I told her when I had one, and the pain was in my kidneys. The pain went off long before the contraction did, coz she kept hold of me the whole time. She made me run up and down stairs a couple of times to try and get me going. I'd told her how Jim's labour had started almost identically, so she said she'd hang around rather than get home and have to come straight back out. I had my first "Oh shit, this is it" contraction around 11:30 and they started coming every 4 minutes after that. I didn't keep track at all, but Suzy did. My best friend Carly arrived around midnight - I told her she didn't have to come considering the hour, but I'm bloody glad she did after everything else that happened. By the time Carly got there, I was contracting regularly but not that painfully. I could still talk except at the very peak. Suzy did a VE around 12:15 and I was 2-3cm, not fully effaced, but very 'stretchy'. I felt a touch dishearted then, but then the contractions ramped up, probably from all the swishing of cervix. My labour 'start' time was 12:30am.

She phoned the second midwife out then. I was alright between contractions, but couldn't work out where I wanted to be when I was having them. I tried the toilet, which was OK. I tried crouching right down into my knees, which was really good for a while. Sue, the 2nd midwife, came out at about 1-ish. She came out in a rush because I was getting a bit pushy. They got nicely set up for the birth and then I tried kneeling on the sofa for the contractions, which was AMAZING. I recommend it. I knelt up the back and leaned on the back with a big sheet folded up under my face to whimper into. I have no idea what time anything much happened after I got on the sofa, mainly coz I had my back to the clock and everyone in the room. I kept trying to join in the conversation between contractions, but I was too buggered to turn round. I remember the midwives telling me I needed to take my trousers off and I thought "Not yet...not yet..." but then I started wanting to push at the top of the contraction, so they took my trousers off for me. It was very undignified for poor Suzy who was crouched between my legs ready to catch.
I had a couple of mega-contractions, and told Suzy I was definitely wanting to push. Then I had transition. I felt sick, but I wasn't sick, and started crying really quietly that I wanted to go to bed and I wanted my mum and suddenly thought "Bugger me, transition already". I don't think anyone heard me, I was mewing like a kitten with the pain, rather than howling. Then everything went really quiet and my next contraction had three pushes at the end of it. Mum and Carly thought I was lying when I said I wanted to push until I started bearing down.
I started pushing around 2:10am. I couldn't coordinate it very well to start with, Mum told me to pull my chin in and focus DOWN so I tried doing that instead and that worked far better. Once his head was up to my cervix, I started getting really emotional and crying that I couldn't do it and I wanted to go to bed and I didn't want to. I remember crying "I can't, I can't, I can't" and everyone else saying "YOU CAN". Then his head crowned and I managed to breathe his head through rather than just push him straight out. I was absolutely SCREAMING by that point. I didn't mean to, I couldn't seem to help it. Then he was out, all flobbetyschlobbety. It was about 2:24am.

I was still facing away from everyone and it took a few seconds to pass him up through my legs. I kept crying that I wanted my baby. He didn't cry immediately, and it seemed an age before he did. He pinked up so fast once I had him and I rolled onto my back so I could feed him. Then I fed him and cuddled him and was a bit WOW.

In the mean time, carnage was happening. He had two true knots in his cord, which I didn't really think about right then, but his cord was thick and jelly-like at the umbilicus from where it was all pushed up. He's been double clamped. I planned to have a physiological third stage, but once the baby was born my womb didn't want to push anymore. Then I started to haemorrhage, so they gave me syntocin quickly and started tugging me about. I just wanted them to piss off and leave me alone, I felt horribly ill from the haemorrhage (my official blood loss was 650ml, so over 3 times the amount I lost with Jim, and it was probably a lot more of that because it went under the shower curtain) and I wanted to faint even though I was sitting down. I managed to push the placenta out myself, then they started fiddling about to see to what extent I'd torn. The light isn't great in my house, but they deduced that I had torn all the way through and would probably need stitching in theatre. By then, I just wanted everyone to FUCK OFF and leave me alone. They called me an ambulance and helped me get dressed and get Jack dressed. My mum washed all the blood off me - I looked like I'd been in a horrible accident, lol.
He was wide awake and staring at me and I had my hand under his bum and he felt like he did in the womb, coz I was so thin I could feel his bum really well within.

A first responder turned up first, to 'stop the clock' as they call it, at which the midwives were most scathing. The full crew showed up not long afterwards. They got me in the ambulance and I sat on a stretcher holding Jack for his first car ride! Mum and Carly followed. All the neighbours must've thought something awful had happened coz I had two ambulances out. I got pulled through A+E on the stretcher and all the beaten up drunks had a look at Jack and said congratulations. I was bunged into CDS and transferred onto a bed.

A consultant came to poke me about some more. He said I'd torn all the way through, but not actually damaged anything in my arse, so I could be stitched as a second degree by a midwife. Neither Suzy nor Sue wanted to stitch me coz my sphincter was visible and they didn't want to fuck me up, so Stevie came to do it. She's the midwife who delivered Jimmy and did an excellent job of stitching that tear. While I was stitched up, they did Jack's weight and measurements.

I was stitched, then had a diclofenac suppository, then started wishing everyone would DIE and leave me alone, because there's only so much vag pulling about I can stand and the doctor was ROUGH. Suzy and Sue went home to sleep - poor Sue had a clinic yesterday and we had a cup of tea and some biscuits. Then Carly took Mum home. It was gone 6am by the time everyone went.
Jack settled nicely and I had a doze for a bit. His dad rang me, having been informed of his son's birth by a barrage of texts and voicemails *eyeroll*. A woman came and did his hearing test, then a midwife came and did his paediatric check. Then I was discharged.

Birth Story - Jimmy, 2009

I'm putting these up here for posterity's sake, rather than to horrify you all while you're eating your lunch, so please skip unless you love gory, onomatopoeic descriptions of birth. 

IN BRIEF:
Gestation: 40w 4d
Site: Hospital
First Stage: 4 days of on and off annoyance, then 2.5ish hours active labour
Transition: ONE. HOUR. NEVER. AGAIN.
Second Stage: 55 minutes
Third Stage: Interminable, probably around 30 minutes
Tearing: Long, internal, second degree
Weight: 9lb 1oz

DETAILS:
On his due date, I had a haemorragic show. I trotted obediently up to the hospital, who found me to be 2cm dilated and likely to start soon. I went home, feeling quite proud of myself for managing to have a well behaved body.
The next morning, I went to see my midwife, who did a VE and sweep and found me in much the same position as before. I bled all damn day and after worrying about the amount of mucusy clots, went to CDS and they said I was fine and to go home and wait for stuff to start.
The next day, we went to my mums because I was in a furiously bad mood and sick of clock watching and being stuck in the house. We went to the pub for lunch and I was getting the odd twinge. Nothing major, enough to make me wince. Around 3pm, I started to get fairly regular, weak contractions. They got slowly stronger until they were coming every ten minutes. Around midnight, they suddenly got very painful and I started getting a lot of HIDEOUS back ache. I couldn't cope with the backache so we went to CDS. Again. Yes, again! A very nice midwife examined me and said I was 2-3cm and not ready yet. I cried. A lot. I really thought that was it. Anyway, we didn't get home til 4am and I still had quite bad backache. I went to sleep but could still feel the pain in my sleep.

The next day, a Thursday, I got up around 10am and had no pain. No pain at all. I was HEARTILY PISSED OFF. I made a decision to stop worrying about every pain and washed my filthy hair, had a nice bath and read a book. I kept falling asleep. We had a curry and watched TV and then decided to watch Bill Bailey as my mum kept telling me laughter would do me good.
Lo! Bill Bailey had been on but ten minutes and I felt a little gush - this was around 9:30pm. Then a bigger gush. I instantly got VERY EXCITED and went to the loo and it was not wee, and I was MOST PLEASED. I phoned CDS, they said to come in. All the way there, I kept losing a little fluid at a time.

The midwife examined me (yet again) and said I was 2cm dilated and my cervix was still in the wrong place. By this time, I was slightly irritated because my cervix appeared to be un-dilating itself. This was before I knew about the variation in finger size that is crucial in gauging dilation. She said my waters were leaking around the baby's head but still intact at the front. She said I could come back in the morning for an induction, or wait for it to happen on it's own. She said they would induce me on Sunday morning if I still hadn't started because of infection risk etc. I opted for Sunday and made an appointment for monitoring on Friday afternoon. The whole time I was in hospital, I was losing fluid. On leaving hospital, my backache started and I started getting small pains.

We got home at midnight and I knew that I'd started properly and it was just a matter of waiting til I couldn't take it anymore. I was still on a bit of a high because I KNEW it was finally happening. The pains suddenly got a lot worse around 1am and I went for a bath. The bath did JACK ALL for my contractions but helped with the shitting backache. I took one paracetamol around then. His dad decided to go to bed for a bit as we'd had so little sleep the night before and we figured we had a few hours before anything dramatic happened. I kept needing to sit on the toilet as I found it easiest to cope with the contractions on there, so he went to bed and I sat on the loo, trying to read a book...
I went and got in bed with him after a bit, somehow thinking that I could get some sleep myself. With hindsight, that was a laughable... I was having MAJOR contractions and trying so hard not to scream and to breathe through them instead and in between, I wasn't really there - I was very much in my head. I managed to let him sleep til around 2:15am and then woke him up screaming WE HAVE TO GO TO HOSPITAL NOW...FUCKING NOW.

I ran downstairs in my knickers, bra and shirt and tried to phone CDS to warn them I was coming. But instead I had a massive contraction and threw up everywhere and had a big loss of water. His dad came down, still half asleep and I was trying to phone CDS again but couldn't stop screaming with the pain so gave him the phone. They said they would get some pain relief ready. You must remember that at this point, I'd only been in labour for two hours and figured I had HOURS to go yet.
His dad had to get me dressed and put a towel down on the car seat so I didn't mess it up and found me a sick bucket. Somehow I was still functioning reasonably well between contractions and managed to wash the bowl I'd been sick in up and get my notes together.

He drove to hospital at 80mph while I was screaming all the bloody way and trying to remember to breathe and I remember thinking that I must be a proper fucking wimp to make such a fuss when I had so long to go. Apparently I told his dad off for driving too fast and what if the police stopped him. I was clearly not entirely with it. At this point, contractions were around 4 mins apart and lasting 40 seconds, with definite peaks and troughs of pain. Nothing like what I thought it would feel like anyway. By the time we got to hospital, it was 2 minutes apart and at the end of every one, I was losing loads of water.

I don't know how the fuck I got up to CDS. His dad had to carry me up the stairs. When we got to the stairs, I declared that I couldn't possibly get up them and I wanted to go home and not have the baby anymore. He just lugged me up the stairs anyway, lol.

CDS were VERY busy and they took ten minutes to find me a room. I don't know how I managed to stand up for that long. It was the birthing pool room, which is kept at a nice 28 bloody degrees. Because it was so hot, they left the door open and put a screen across it. I then deafened the entire hospital
I spent the next twenty minutes in the toilet screaming and asking why I needed to push and I couldn't push because I'd break my cervix and why the fuck did I need to push and where the FUCK were the DRUGS?? Annoyingly, there were two canisters of entonox in the room with no way of using it. I felt they were taunting me. In between contractions, I was just talking complete gibberish about wanting to get in the giant bath. His dad kept trying to touch my back or bump to calm me down and I was yelling at him to get off me. It was the most frenetic moment of my life those last few minutes before the midwife came in.
The midwife (Stevie) came in, took some history and my obs and then asked me to lie on my back for an examination (I was all over the place until then, mainly on my side). I told her I wanted to push. I laid back and she did it and just as she finished, I had another contraction. She told me to be quiet and listen (in a nice way) and told me I was fully dilated and if I wanted to push, that was fine. Oh and did I want any pain relief? I asked how long it would be, she said an hour max and I said no, I would be fine! She said she was going to get another midwife to assist and wouldn't be very long. She came back with a student to help.

I remember saying over and over that I'd done it by myself and I couldn't believe it. His dad was absolutely shell shocked. I didn't have time to change position or my t shirt or anything. I hadn't even brought the labour bag, with the camera in, up.

In between pushes, Stevie was asking me about my birth preferences, which is hilarious looking back. I remember being amazed that it didn't hurt once I knew the baby was coming. It was a huge HIGH just to know that I'd done it without any help. God did I make some noise though, I was like something out of the Exorcist. The midwives were absolutely brilliant and kept telling me how well I was doing and to breathe slowly in between and try and relax when I could and how to position myself to take better advantage of the pushing. His dad just held my hands really tight, and kept stroking my head with some wet tissue paper (no time for flannels) and it kept falling in my eyes and making me laugh. Everytime I opened my eyes, I remember being amazed that I was in hospital having a baby.
The baby's head crowned and I remember yelling "Shit that stings", even though it actually didn't, and they told me that they would ask me to push, then pant, then push again. His head came out and then his body and that felt WEIRD and then they plonked him straight on me, this giant red and blue and purple baby that somehow used to fit inside me. With a giant blue umbilical cord that weighed a ton.

I was sort of in shock for a second at this little person. The student cut the cord because his dad didn't fancy it. They gave me the syntometrine which I consented to in labour because I was absolutely PETRIFIED of haemorrhaging. And then he was all ours and on top of me and I was still wearing my bra and t shirt, lol. His dad said something about him being a boy and then we all sort of calmed down a bit. The placenta came out around 20 minutes later, although it felt like five minutes and felt very odd when it came out, like having another baby. They said it was a very large placenta and would barely fit in the bowl! I didn't look.

Stevie cleaned me up and I asked her if I'd torn and she said yes and she was going to have a look if I needed stitches. They put a towel over the baby and I was in a strange half-sitting position and couldn't get my bloody bra off. I managed to eventually, and then fed him. He seemed to know exactly what to do although he didn't suck for long. Stevie said I needed some stitches and went off to prep. They put me in stirrups, but it wasn't uncomfortable at all. I wasn't really aware of anything except having this baby all of a sudden.

His dad held the baby for ages while I was being put back together and was very nervous of him. I have to admit, I was a bit scared. He was really wriggly and slippery. He pinked up nice and quickly though. I know I fed him again, but I don't remember when. His dad went and phoned parents to inform them that I'd finally dropped and it'd all been rather quick. I went and had a bath, which was a shock. No bump and outrageous bleeding. I knew the bleeding would be bad, but it's still a shock when you've been period free for so long! I went back, had some food which made me feel horrible and then walked over to the postnatal ward.

And I sat upon the fucking PN ward until 9:30pm. I'd requested a 6hr discharge and they said they would aim for lunchtime as I was fine. The physio came round and I had a blood test to check my iron stores. My womb went down brilliantly. A midwife came round and taught us how to give him a bath. He failed his hearing test, twice, because he had such a wet delivery .There was a midwife handover at 3pm and that was the last time I saw anyone until 8pm, which is pretty shitty by any standards.

The paediatrician came round and frightened us by telling us he should be feeding every 3 hours when he hadn't been fed since I'd gone on the ward at 9am. He's also got an undescended testicle, which is very common. His dad got in a panic about the feeding and we tried to feed him but he wasn't interested. I wasn't worried, as he'd fed three times since delivery and had latched on etc very well. A fucking horrible old cow of an auxillary came and said they wouldn't discharge me unless he fed. 8pm is kick out time for dads, and she tried to make him leave so I burst into tears and he went and complained to the nearest midwife. Who happened to be the head of CDS. She came round to talk to me and I said that if he hadn't fed again by 4am, I would come back and admit myself and I really didn't want to stay in hospital and would self discharge otherwise. She said she would get my midwife to come round and have a chat.
My midwife, Hayley, came and apologised profusely for not seeing me before as they were mighty short staffed and had two emergencies. She had a look at me and him and said she was happy for me to go home and it was entirely usual for newborns not to feed for a long time after birth and as he'd had three shitty nappies and sicked up a lot of crap, he was probably fine. She was nice, I wish she'd been around earlier than I might have got home earlier.
We got packed up and off we went, me hiding the fact I was feeling incredibly faint and dizzy. I hadn't managed to sleep at all all day, constantly expecting to be discharged home. We got back to ours and the grandparents all popped in for a look, which I didn't mind. Sure enough, he wanted feeding as soon as we got in the door and then every 2 hours after that. My mum cooked me some food as I hadn't eaten for over 24 hours, and then we were left alone with our tiny boy.

Anxiety

My second child, Jack, is tiny for his age. He doesn't grow properly, and has poor gross motor skills. He doesn't care - he hurls himself round like a child twice his size. He's being measured again next month, and if his growth is still too far under what it should be, he will probably need a referral to check up on him. He's currently on the 9th centile for height, and 50th centile for weight. He is a BALL and he bounces accordingly. He's normal, otherwise, developmentally, so we don't worry too much.

Jack suffered from intrauterine growth retardation (IUGR) when he was inside me. My bump stopped growing at 34 weeks. When I was in labour at 42 weeks, my bump measured 33cm. It should have been around 42cm. His smallness was noted, but no action was taken. It was assumed by my midwives that I was losing a lot of weight from my marital split, and therefore I had a smaller bump.
To demonstrate how small I was:

34+5 with Jack. 20w with current baby.

I put on 8lb total in that pregnancy. At 38 weeks, a different midwife worried he was breech and sent me for a scan. His foetal weight was estimated at 7lb. At 40 weeks, my usual midwife finally sent me for a growth scan, because I was on call for a homebirth with a clinically SFD baby. They estimated his foetal weight at 8lb, and sent me home to wait for birth.
He was born two weeks later, at 42 weeks precisely, on my sofa after a predictably short labour. I was due to be induced six hours later, but had a strong feeling that having my waters broken or labour augmented would be the wrong decision. I also woke up the day before he was born convinced he would die. I'd had a lot of negative thoughts like that in the buildup to having him, but that was an acute, passionate feeling of something going wrong.
He suffered decelerations during his second stage of labour, but since I was at home, there wasn't much to be done except push harder. He was born in fine fettle, quiet and alert with a head of long, gingery hair. But his cord had nearly killed him.

Jack's cord had two, true, figure-of-eight, tight knots in it, about 10cm apart. One true knot is fairly rare, and is one of more common causes of stillbirth. Two knots is so rare as to be reported in medical journals. They had been in place since around the 9th week of pregnancy. They could have tightened, and killed him, at any point from them. They'd reduced his placental flow. They'd given him a thick, horrible cord. They'd tightened as he was being born. The backflow from this caused me to have a fairly horrible haemorrhage as I lay cuddling him.

He survived. I'm still not sure how. He weighed 7lb 12oz, which was 25th centile using the universal centile system, 8th centile for my particular variables. His growth scans had overestimated his weight considerably. In comparison, his older brother was 9lb 1oz, and almost two weeks earlier.

Isn't he gorgeous?

His birth has left me with anxiety and fear about this baby like you wouldn't believe. I am under consultant care, more for the haemorrhage and IUGR than the knots themselves. There is no way to predict or diagnose true knots before delivery. I'm having growth scans to check this baby grows to my schedule (which predicts a term birthweight of around 9lb) and also to check umbilical flow. I want another homebirth, but nothing can be decided until they know the baby's growth is OK.

This would be fine and reassuring (and it is), except I've also got a lot of bad feelings that have resurfaced about Jack's pregnancy. I suffered from severe antenatal depression when I was expecting him, primarily because my ex left. I wasn't concerned about his lack of growth. I didn't care. I'm quite sure had I displayed any concern for my tiny bump, they would have perhaps picked something up sooner. Instead, I ignored it. I ignored him. It was easier.
I get flashbacks. All the time. They're usually related to significant pregnancy events, like midwife appointments, endless blood tests and scans, but also the general condition of pregnancy is a reminder. I never wanted to feel how I did when I was expecting Jack again. I never wanted to wake up hating the world, dreading the day ahead, fearing every phone call, not wanting to leave the house.
But I do.

Not all the time. But the flashbacks are vicious and they hurt. They are like normal pregnancy anxiety + the anxiety I should have had for Jack + guilt + anger that I was ever made to feel like that. I cry a lot, and I let myself do it. I'm trying to get this grief and anger and pain and terror out of the way, in the most natural way I can think of. I sat on it last time. I can't do that again.

In many ways, feeling like this is normal. Feeling like this a natural consequence of my last pregnancy. Pregnancy is never just about THIS baby, it's about all the babies that have been before.
It may also be related to the B12 deficiency anaemia I get in every pregnancy. B12 is one of those vitamins that you don't realise you need until you haven't got enough. Then your nerves stop working properly, you faint a lot, you become depressed, you feel so tired you might die, and you go a ghastly luminescent colour. I haven't had my blood tested since November, but I suspect it's contributing to the feelings of doom.

It's just hard. It's hard to talk to happy, first time pregnant ladies and compare notes, without sounding like a doom-laden horror crow. I've never wanted to be a woman who terrifies people with birth stories, but it seems to happen anyway. It's hard to be honest when people ask how it's going, to not just weep because I can't walk properly (possible side effect of birth injury, I've got physio next week, thank god) and I'm so tired, and I'm so scared.

But it's not all the time. And the crucial difference is that I want this baby. I'm terrified because I want him to be OK so much. I want a safe birth. I want a healthy child. I want to be well afterwards - I really wasn't well after Jack was born, because of birth injuries and haemorrhaging, and I'm afraid of that happening again. I want so much that most people take for granted with their pregnancies, and all I can concentrate on is how it might go wrong.

I've not written this for sympathy, or anything really except in the hope that giving it an audience might help somehow. If anyone wants to see the double knotted cord, shout and I'll send you the picture - it's way too grim to post on here though.
Only 18 weeks to go!

Studying with the OU when pregnant

I'm a little over halfway through my fifth and sixth uni modules. It's going quite well, and I'm astonished that this is my penultimate year. I started 37 months ago!
I'm also halfway through my third pregnancy.

Pregnancy has given uni work a new dimension of difficulty that I didn't expect:

 - It is much, much harder to not procrastinate. I have lost all self-discipline. If I want to sit and watch two hours of Extreme Makeover: Home Edition and wail, then I do. I'm not particularly behind, but I do struggle to juggle it all.

- It is harder to remember everything. Baby brain is, unhappily, not a total myth. Some days I'm fine. Some days, I'm wading through mental custard.

- Pregnancy is not an illness. Alas, it causes me to be rather ill. Several months of morning all-day sickness, a wonky hip, sciatica, SPD, anaemia, and sheer exhaustion has somewhat knocked me for six. All these things are either resolving or in line for treatment, so hopefully I should feel better soon, but I recommend you aim for your first trimester to be in the summer break!

- My working habits have altered. Before, I got all my work done in the morning when I was full of the joys of spring. Now, I'm fairly useless first thing in the morning, and completely useless mid-afternoon. I have to work round it.

Despite all this, I'm doing OK. I actually got a pass one in my first level 3 TMA - my first ever pass one in an essay-based subject. I've dropped off a bit since then, but I'm hoping for a pass two overall. TMA writing is hard, because I feel woolly a lot of the time - not to mention stressed! It's so hard to remember everything and write something incisive.
The real challenge will be that I don't finish this year until I'm 36 weeks pregnant. I've got an EMA, which should be OK because I can put that together over time. It's the exam that worries me. Not so much from a "WHAT IF I GO INTO LABOUR???!!?!?" perspective, because that's unlikely. It's more about the sitting-uncomfortably-for-three-hours. BUT I WILL COPE!

Then I get my results around when the baby's due, when they'll have become a distant memory in a haze of sleepless feeds. So, hurrah!

Choice (...or the biomedical dominance of obstetrics)

Why does pregnancy and birth often mean the loss of autonomy and free choice for women?

At no other stage in life have I been encouraged to have a flu jab with quite the demented intensity as in the last four months. I've always qualified for one, and never had one, and nobody has ever cared until NOW. Now, I know the risks of flu in pregnancy, and I know how little difference the flu jab makes to anything, so on balance I prefer not to put anything in my body I haven't had in there before (please don't confuse this with some sort of raging anti-vaccination stance - I don't react well to any vaccination and prefer not to have them if it's not strictly necessary).
I've also been told I WILL HAVE the whooping cough vaccination at 28 weeks. Again, I understand the rationale, actually completely agree with it, and will happily have it. But I've not been asked to consent. I've not even been told that dissent is an option.
I've been told I MUST have a GTT (glucose tolerance test, a blood test for diabetes) at 28 weeks on account of being fat and having had a big baby. Now, my 'big baby' was actually spot on in weight for my height and ethnicity, according to the hospital's own growth chart system. I've also had a majorly underweight baby. I've never had diabetes in my life, and certainly not in pregnancy, and yet I have been told to go to the hospital and have this test (which takes two hours) and have never been given the opportunity to dissent, or had it explained that it is a choice.

Then you have the large number of people, including politicians, who believe smoking and drinking in pregnancy should be illegalised. Now, it is perfectly legal to actually kill your baby before 24 weeks of pregnancy, if you want to, provided you go through the proper channels. How can you decide, in law, that a baby has no rights to life before 24 weeks, but definitely has the right to not to be poisoned? It's a totally flawed argument, with extremely limited evidence. As it is, you're told to stop drinking and smoking the second you find out you're pregnant. Now, this has never been a problem for me - I don't smoke, and I don't drink if I suspect I'm pregnant - but it's a big problem for a lot of other women, particularly smokers.

Every single woman in England, if not the entire UK, has the right to ask for, and be permitted a homebirth except in high risk circumstances. Yet, I know many women who are never told it's even an option where they live. Presumably this is why homebirth rates are so low. I want a homebirth, and will blog about the whys and wherefores later on in pregnancy, but I've already had to see a consultant to be 'approved' for one, based on a one-off situation that's unlikely to be repeated. There is a strong sense among obstetricians that homebirths are inherently risky, as opposed to the safety of a hospital birth, ignoring the simple truth that BIRTH is a risky business, and yet women have been doing it to varying degrees of success since we evolved into bipeds.

Much is made of choices around labour. My maternity notes have a whole page in which to discuss my birth plan, and explain on what I would like to happen. Dear reader, I will totally ignore that page, because I know full well that the second something in my labour changes, that plan will get lobbed out the window. I strongly advise you to do the same. Birth choices are only acknowledged and acted upon until something changes. That can be as simple as not having a waterbirth because the waterbirth room is already occupied, to labouring far too fast to have a chance to light the myriad candles and incense, to needing an emergency caesarean. And women are not really made aware beforehand that the time and effort they put into organising their birth choices and preferences in their head, and in their notes, is wasted the second something goes slightly awry. This in itself can lead to angst and unhappiness postnatally.

Women's choice in labour is removed entirely if a risk is detected. Few women are ever given what would normally be called 'informed choice' prior to an emergency caesarean, on the basis that there simply isn't time. This can be accepted, if the baby or woman is dying. However, often women aren't given informed choice when there is no immediate risk to life. I've discussed how induction is rarely explained as an option rather than an inevitability. I was told when I was overdue with my last baby that it was up to the consultant whether I could decline an induction. Er no, it's definitely up to me!
The same can happen with episiotomy, although less so than in the days (1950s-1980s) when episiotomy was done as standard, and one woman was CUT AFTER DELIVERY so the midwife wouldn't get into trouble for not doing it during the birth.
Too often, in the chaos of the delivery room and the fear of perinatal death, the birthing woman is not told what is happening, what has gone wrong, and what needs to happen next.

I don't understand why women's choice is so heavily curtailed in pregnancy and birth. Are we really to be thought of as silly children, who are incapable of understanding risk? Who would put our own prejudices above the health of our babies? Are we thought of as not able to understand the rationale and say no, regardless of what current NICE guidelines are? I mean, it's not like consultants follow the NICE guidelines about perinatal care half the time anyway.  Perhaps the real problem is that midwives and consultants simply don't have the TIME to properly explain the reasons for certain tests and advice.
The only real choice I feel I've been given so far is whether or not to have the sexual health blood screening for HIV and syphillis, and whether or not to have the NT scan. Everything else has been done to me.
It's a strange feeling, to feel as though your body is not really your own anymore, simply because there's another person in it.